注药速度与注药部位对依托咪酯诱发肌阵挛的影响

Effect of intravenous injection rate and site of etomidate on etomidate induced myoclonus

目的:探讨不同注药速度与注药部位对依托咪酯诱发肌阵挛的发生率与出现时间的影响,为临床使用提供参考价值。方法:选取100例ASA患者,分为A、B、C、D四组,依托咪酯静脉注射。A组注药部位:前臂静脉通道,注药速度:15 s;B组注药部位:足背或踝前大隐静脉通道,注药速度:15 s;C组注药部位:右颈内静脉或右锁骨下静脉通道,注药时间:15 s;D组注药部位:前臂静脉通道,注药时间:60 s。结果:A、B、C、D四组的肌阵挛发生率分别为48%、44%、52%、20%,肌阵挛开始出现时间分别为(65.2±1.6)s、(108.3±1.1)s、(40.7±1.2)s、(90.3±0.5)s;C组肌阵挛出现的时间比A组明显提前,差异有统计学意义(P<0.05);D组的肌阵挛发生率比前三均组明显下降,差异有统计学意义(P<0.05),肌阵挛出现的时间比A、C组明显滞后,差异有统计学意义(P<0.05),比B组明显提前,差异有统计学意义(P<0.05)。结论:相同条件下(部位与剂量相同),不同注射速度对肌阵挛发生率和出现时间有一定影响;相同的速度注射相同剂量的依托咪酯,肌阵挛的出现时间在中心静脉通道快于外周静脉通道。

Objective Study of different injection rate and injection sites on etomidate induced myoclonus incidence and onset time effect,as to provide reference for clinical use. Method 100 cases of patients with ASA were divided into A,B,C,D group,etomidate intravenous injection. Group A site： forearm venous channel,injection speed： 15 s; group B： part of dorsal foot or ankle before the great saphenous vein channel,injection speed： 15 s; group C： part of the right internal jugular vein or subclavian vein channel,injection time： 15 s; group D site： forearm venous channel,injection time： 60 s. Results A,B,C,D four groups of myoclonus occurrence rates were 48%,44%,52%,20%,respectively,myoclonus began to appear time were（ 65. 2 ± 1. 6） s,（ 108. 3 ± 1. 1） s,（ 40. 7 ± 1. 2） s,（ 90. 3 ± 0. 5） s,respectively; group C myoclonus appears time obviously earlier than A group,the difference was statistically significant（ P〈0. 05）; D group of myoclonus incidence than the previous three were significantly decreased（ P〈0. 05）,myoclonus appearing time lags behind obviously than the A and C group（ P〈0. 05）,significantly earlier than B group（ P〈0. 05）. Conclusion Under the same conditions（ position and the same dose）,different injection velocity and the incidence ofemergence time has a certain effect on myoclonus; the same speed injection of the same dose of etomidatemyoclonus,time of occurrence in the central venous access faster than peripheral venous channel.